Migration, differential access to health services and civil society’s responses in Japan
In November 1991, Jeevan Shrestha, a 22-year-old migrant worker from Nepal, fell sick in Japan.1 Four months later in a clinic in the city of Hamamatsu, Shizuoka Prefecture, he was diagnosed as suffering from a fatal deﬁciency in the arterial valves of his heart. To save his life, Dr Hiroshi Taniguchi, who examined the patient, decided that he needed to undergo open-heart surgery to replace his failing arterial valves with artiﬁcial ones. The surgeon estimated the cost of surgery at more than ﬁve million yen (US$45,000), plus more than two million yen (US$18,000) for hospitalisation, medication and treatment.2 Shrestha was an unauthorised (illegal) visaoverstayer who was ineligible for public health insurance, as a result of which public funds would not be available to him. This posed a serious dilemma for Dr Taniguchi and his colleagues in the general hospital where Shrestha was admitted. By then, local media had featured his story, attracting a great deal of public attention in the city and its vicinity. In response, sympathetic citizens sent donations, a total of 600,000 yen (US$5,400), to contribute to his surgery, while a group of volunteers coordinated efforts to assist him. Doctors and citizens alike wished to save Jeevan’s life but faced a dilemma: who was going to pay his huge medical costs?